Transcript Urology_SSG_NICE_2015

NICE GUIDELINES FOR SUSPECTED CANCER:
RECOGNITION AND REFERRAL
JUNE 2015
UROLOGY SSG MEETING
15 October 2015
Jamal Ghaddar, Matthew Goh
Department of Urology
Weston General Hospital
BACKGROUND
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NICE Guidelines for Suspected Cancer 2005.
2WW, 31-Day and 62-Day Targets.
2WW Referral Form.
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NICE Guidelines for Suspected Cancer 2015.
New Cancer Strategy 2015-2020.
4-WEEK GP Referral to Decision to Treat.
2WW Referral Form or Cancer Concern Form?
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Who triages the 2WW referrals in your hospital?
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A. PROSTATE CANCER
Refer for an appointment within 2 weeks:
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Prostate feels malignant on digital rectal examination. [new
2015]
PSA levels are above the age-specific reference range. [new
2015]
A. PROSTATE CANCER (DISCUSSION)
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Specify features of a malignant-feeling prostate?
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PSA/DRE specified in the referral?
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Define the PSA age-specific ranges?
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UTI to be excluded, with repeat PSA following treatment?
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Clarify pathway for patients with reduced life expectancy?
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Clarify pathway for men over 80 years?
B. BLADDER CANCER
Refer for an appointment within 2 weeks:
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Age ≥45: visible haematuria (unexplained) without urinary
tract infection. [new 2015]
Age ≥45: visible haematuria that persists or recurs after
successful treatment of urinary tract infection. [new 2015]
Age ≥60: non-visible haematuria (unexplained) and either
dysuria or a raised white cell count on a blood test. [new
2015]
B. BLADDER CANCER (DISCUSSION)
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‘Unexplained’ haematuria?
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Definition and diagnosis of UTI?
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Definition of successful treatment of UTI?
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Definition of dysuria?
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Specify what constitutes a raised WCC?
C. RENAL CANCER
Refer for an appointment within 2 weeks:
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Age ≥45: visible haematuria (unexplained) without urinary
tract infection. [new 2015]
Age ≥45: visible haematuria that persists or recurs after
successful treatment of urinary tract infection. [new 2015]
C. RENAL CANCER (DISCUSSION)
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Incidental renal lesions on imaging?
D. TESTICULAR CANCER
Refer for an appointment within 2 weeks:
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Non-painful enlargement or change in shape or texture of the
testis. [new 2015]
Consider a direct access ultrasound scan for testicular cancer in
men with unexplained or persistent testicular symptoms. [new
2015]
D. TESTICULAR CANCER (DISCUSSION)
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Specify body of testis?
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Clarify change in texture?
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State findings on transillumination?
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The use of Valsalva?
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The use of direct-access ultrasound?
E. PENILE CANCER
Refer for an appointment within 2 weeks:
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A penile mass or ulcerated lesion, where a sexually transmitted
infection has been excluded as a cause. [new 2015]
A persistent penile lesion after treatment for a sexually
transmitted infection has been completed. [new 2015]
Unexplained or persistent symptoms affecting the foreskin or
glans. [new 2015]
E. PENILE CANCER (DISCUSSION)
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Clarify time period after STI treatment when the lesion is
considered ‘persistent’?
GU medicine involvement?
Clarify unexplained or persistent symptoms affecting the foreskin
and glans?
State the features of benign Peyronie’s disease?